Status asthmaticus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Status asthmaticus is an acute exacerbation of asthma that does not respond to standard bronchodilator and corticosteroid therapy. Symptoms include chest tightness, rapidly progressive dyspnea, non-productive cough and wheezing. Status asthmaticus if left untreated may result in severe bronchospasm, mucus plugging and rapidly develops acidosis and respiratory failure as a consequent of carbon di oxide retention and hypoxemia.

Epidemiology

Approximately 10% of the US population is affected by asthma with status asthmaticus requiring highest rates of hospitalization.

Predisposing factors

• Increase use of bronchodilator despite resistance,
• Frequent exacerbations despite the use of corticosteroids,
• Despite adhering to therapy, a peak flow rate of less than 10% from baseline,
• Frequent hospitalization for acute attacks,
• History of syncope or seizure during an acute asthmatic attack,
• Oxygen saturation lower than 92% despite supplemental oxygen,
• Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a silent chest with the absence of wheeze suggestive of an imminent respiratory arrest.

Diagnosis

History and Symptoms

• Rapidly progressive dyspnea
• Non-productive cough
• Profuse sweating
• Cyanosis
• Loss of consciousness and/or seizure secondary to severe hypoxia may be observed
• Inability to speak more than one or two words may be observed with severe airway obstruction

Physical Examination

Vital Signs

• Early stages:

• Increased respiratory rate greater than 30 cycles per minute
• Increased heart rate
• Pulsus paradoxus (a fall of SBP greater than 20-40 mmHg during inspiration)

• With progressive untreated airway obstruction, increased work of breathing may result in bradycardia, hypoventilation and cardiorespiratory arrest

General Physical Examination

• Sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration
• Use of accessory muscles of respiration

References

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